Choosing a good death: Bendigo hearings for state inquiry into end of life choices

The committee is examining the need for Victorian laws to allow people to make informed decisions about ending their lives by exploring how current medical practices help people manage the process.

Regional hearings are being held across the state with Warrnambool and Geelong having already given evidence.

Chairman of the committee Edward O'Donohue says it is important the committee visit many parts of Victoria, not only because it is an issue of significant public interest that affects all members of the community, but because the needs of rural and regional Victorians are different.

"The specialist care is obviously sometimes difficult in a more remote area or outside of Melbourne," he said.

"Some of the service provision in the home can be particularly challenging particularly on farms or away from a major population centre."

Dr Jason Fletcher, an Intensivist and advance care planning lead from Bendigo Health agrees with Mr O'Donohue. He said the biggest problem lies with the level of care that can be delivered at home.

According to him a 'good death' involves a patient being surrounded by their friends and family; dying with autonomy and control and without troublesome symptoms.

"I think in hospital we can do that but that's not meeting the needs of approximately two thirds of people who do prefer to die at home or would prefer to die at home," said Dr Fletcher.

End of life choices is a complex issue according to Dr Fletcher. He says it is very difficult to define when end of life actually commences, and varies from individual to individual and is compounded by the lack of study in the area.

"It's something that has never really been defined in the medical or other literature before," he said.

But he does think there are definite trigger points particularly when it comes to chronic illnesses, including cancer and non-cancer diagnosis and those people dealing with aging who are considered frail.

Dr Fletcher says there are two crucial areas that need addressing. The first one is about creating a legal framework that recognises the treatment plan of patients.

"People need to be able to plan for what treatments they do and don't want and that should have some binding in law that clinicians and the health system should respect, provided they've been made by a competent person," said Dr Fletcher.

The second change he would like to see in the legislation is around addressing future illnesses.

"At the moment if you want to refuse care it has to pertain to an illness that you have at the moment and I believe a refusal to have certain care should address not only a current illness but also a future illness," he said.

The other key area Dr Fletcher would like to see change is around education about end of life choices for both the community and the clinicians working in the field.

He wants the diagnosis of the dying patient addressed and discussed.

"The focus of education of clinicians focuses on cure rather than acknowledging that death may come about and it's time to opt out of medical treatment," said Dr Fletcher.

Dr Fletcher said people aren't necessarily scared of death or dying, that instead it's a human need to be reassured that health professions can provide a pain free death as much as possible.

"They are scared of how that's going to come about and the greatest fear is that people might suffer while there undergoing the dying process, as a medical profession and as a community we need to address that," he said. "